Surgery Overview

Cystectomy is the surgical removal of all or part of the bladder. It is used to treat bladder cancer that has spread into the bladder wall (stages II and III) or to treat cancer that has come back (recurred) following initial treatment. There are two types of cystectomy:

• Partial cystectomy is the removal of part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area. Partial cystectomy is only a good choice if the cancer is not near the openings where urine enters or leaves the bladder.
• Radical cystectomy is the removal of the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may contain cancer cells.
  • In men, the prostate, the seminal vesicles, and part of the vas deferens are also removed.
  • In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed.

Preoperative testing may include CT scan of the pelvis, abdomen, and chest, as well as a barium enema or colonoscopy. Sometimes the doctor will also recommend a cardiac stress test before surgery.

Regional lymph nodes may be removed (lymphadenectomy) during cystectomy. Removing lymph nodes helps your doctor determine whether cancer is present in the lymph nodes and provides more accurate information about the stage of the cancer.

What To Expect After Surgery

Cystectomy usually requires a hospital stay of at least 3 to 7 days. You can expect some discomfort during the first few days after surgery. This discomfort is usually controllable with home treatment and medication. Complete recovery usually takes 6 to 8 weeks.

Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body.¹

• An ileal conduit (also called a noncontinent diversion) uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. This procedure is called a urostomy. After a urostomy, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day, and a larger bag that allows for longer storage can be worn overnight. You will also learn how to care for your urostomy.
• A continent reservoir (continent diversion) uses a segment of your intestine to create a storage pouch that is attached inside your abdomen. There are two types of internal continent reservoirs.
  • Abdominal diversion reservoir. The pouch inside the abdomen connects to an opening (stoma) in the skin (urostomy). This opening is smaller than the opening for an ileal conduit. And because there is a pouch inside the abdomen, no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night.
  • Orthotopic diversion. The pouch in this procedure is sometimes called a bladder substitution reservoir. If your urethra was not removed as part of the cystectomy, you may be able to have this type of procedure. In an orthotopic diversion, the pouch is attached to your ureters at one end and your urethra at the other. This allows you to pass urine through the same opening as you did before surgery. Some people may need to use a catheter to release the urine.

Additional treatment may be needed following a radical cystectomy and may include radiation therapy or chemotherapy. Biological therapy may be used after a partial cystectomy for early-stage tumors.

Follow-up for a partial cystectomy includes cystoscopy and urinary exams every 3 to 6 months for at least 2 years, with regular ultrasound, intravenous pyelogram (IVP), or CT scans of the pelvis and abdomen.

Why It Is Done

Cystectomy is used to remove and attempt to cure cancer that has invaded the wall of the bladder or has come back (recurred) following initial treatment or has a high chance of spreading.

How Well It Works

About 75% of people who have a cystectomy for bladder cancer in the muscle of the bladder are disease-free after 5 years. People with more deeply invasive bladder cancer have a 5-year survival rate of 30% to 50% after cystectomy.²

Risks

Complications are common after a radical cystectomy and may include:^{1, 3}

• Acidosis. This in an imbalance in electrolytes such as calcium and potassium. It can be caused by using a part of the intestine to divert urine after a cystectomy. People with acidosis often need to take medicine to control it.
• Urine leak.
• Infection.
• Fistula formation.
• Bowel obstruction.
• Rectal injury.

Cystectomy can also lead to erection problems if nerves are damaged during surgery.⁴ For more information, see the topic Erection Problems.

What To Think About

You may donate your own blood (autologous blood donation) to use during surgery if needed. If you choose to do this, start the donations several weeks before the surgery so that you have time to donate enough blood and rebuild your blood volume before surgery.

In the past, cystectomy done on men usually removed the nerves that control erections. Now nerve-sparing procedures may be used to avoid damaging the nerves that run alongside the prostate.

Historically, a woman's vagina was removed along with the bladder in a radical cystectomy, making sexual intercourse impossible. Surgeons now are able in many cases to spare or repair the vagina.

If the bladder is removed, the surgeon will create another way to collect urine. You may have a pouch inside your body (continent reservoir or continent diversion) or wear a bag outside your body (ileal conduit or noncontinent diversion).

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. Shipley WU, et al. (2005). Cancer of the bladder, ureter, and renal pelvis. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1168–1185. Philadelphia: Lippincott Williams and Wilkins.

2. National Cancer Institute (2006). Bladder Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional.

3. Jiminez VK, Marshall FF (2002). Surgery of bladder cancer. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 4, chap. 79, pp. 2819–2844. Philadelphia: W.B. Saunders.

4. Small EJ, Grossfeld GD (2003). Bladder. In M Dollinger et al., eds., Everyone's Guide to Cancer Therapy, 4th ed., pp. 401–411. Kansas City: Andrews McMeel.

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